Suboxone is not approved to treat alcohol cravings, but there is evidence that its active ingredient, buprenorphine, can reduce alcohol consumption under certain conditions. The picture is more complicated than a simple yes or no. Buprenorphine appears to have a dose-dependent, dual effect on drinking: lower doses may actually increase alcohol intake, while higher doses reduce it.
How Buprenorphine Affects Alcohol Cravings
Your brain’s opioid system plays a significant role in how rewarding alcohol feels. Buprenorphine, the main active ingredient in Suboxone, is a partial activator of the brain’s primary opioid receptors. That means it partially stimulates the same receptors that alcohol’s pleasurable effects depend on. But buprenorphine also activates a second type of receptor called the NOP receptor, and this is where things get interesting.
Animal research published in Biological Psychiatry found that buprenorphine has opposite effects depending on the dose. At low doses, it acted like a typical opioid and significantly increased alcohol consumption. At higher doses, it markedly and selectively decreased drinking. When researchers blocked the NOP receptors, the alcohol-suppressing effect disappeared entirely, confirming that buprenorphine’s ability to reduce drinking depends specifically on NOP receptor activation, not its opioid effects.
This dual action is important because it means buprenorphine isn’t a straightforward anti-craving medication for alcohol the way it is for opioids. The dose matters enormously, and the therapeutic window for reducing alcohol intake may differ from the doses typically used to treat opioid dependence.
What Clinical Evidence Exists
A secondary analysis from the CTN X:BOT trial, one of the larger studies comparing Suboxone (buprenorphine-naloxone) to extended-release naltrexone in people with opioid use disorder, also tracked drinking outcomes. Both groups reduced their alcohol consumption from baseline by a small to medium amount. There were no significant differences between the two medications for any drinking measure, including time to first drink and time to first heavy drinking day.
That finding cuts two ways. On one hand, naltrexone is one of only three FDA-approved medications for alcohol use disorder and has solid evidence behind it for reducing drinking. The fact that buprenorphine-naloxone performed equally well suggests it does have a meaningful effect on alcohol consumption. On the other hand, neither medication was being prescribed specifically to target drinking in that trial, so the reductions may partly reflect broader changes in behavior during addiction treatment rather than a direct pharmacological effect on alcohol cravings.
Suboxone Is Not Approved for Alcohol Use Disorder
The FDA has approved three medications specifically for alcohol use disorder: naltrexone, acamprosate, and disulfiram. Buprenorphine and Suboxone are approved only for opioid use disorder. Any use of Suboxone to target alcohol cravings would be considered off-label, meaning a provider is prescribing it for a purpose it wasn’t specifically tested and approved for.
If you’re struggling primarily with alcohol cravings and don’t have an opioid use disorder, naltrexone is the closest pharmacological relative to what buprenorphine does. Naltrexone blocks opioid receptors more completely, which blunts the rewarding buzz from drinking and reduces the urge to keep going once you start. It has decades of clinical trial data supporting its use for this purpose.
The Risk of Drinking on Suboxone
If you’re already taking Suboxone for opioid dependence and wondering whether it will also curb your desire to drink, there’s a critical safety issue to understand first. Combining alcohol with buprenorphine can cause dangerously low blood pressure, severe sedation, slowed breathing, and in some cases, coma. Post-mortem research reviewed by the National Institute on Alcohol Abuse and Alcoholism suggests that alcohol lowers the threshold at which buprenorphine becomes lethal in accidental overdose cases.
This means that even if Suboxone has some effect on alcohol cravings, drinking while taking it is genuinely dangerous. The sedative effects of both substances compound each other in ways that are difficult to predict, and the risk increases with the amount of alcohol consumed.
What This Means If You Have Both Disorders
People with both opioid and alcohol use disorders are common in clinical practice, and this is where the question becomes most relevant. If you’re prescribed Suboxone for opioid dependence and also drink heavily, the clinical evidence suggests your Suboxone may provide some reduction in drinking, roughly comparable to what naltrexone would offer. But it’s not being dosed or monitored for that purpose, and the safety risks of combining the two substances are serious.
For people in this situation, the most effective approach typically involves addressing both disorders directly. That might mean continuing Suboxone for opioid cravings while adding a separate, targeted treatment for alcohol use. Naltrexone can’t be combined with Suboxone (it would block buprenorphine’s effects and could trigger withdrawal), but acamprosate works through a different brain system entirely and can safely be used alongside buprenorphine-based medications.
The bottom line: buprenorphine has real biological potential to reduce alcohol consumption, and the research confirms the effect exists. But the dose-dependent nature of that effect, the lack of FDA approval, and the serious dangers of mixing alcohol with Suboxone all mean it’s not a reliable or safe strategy for managing alcohol cravings on its own.